OBJECTIVE: To evaluate real-world patterns of proton pump inhibitor use, treatment compliance, and patient-perceived effectiveness in the control of gastroesophageal reflux symptoms and their impact on quality of life in...OBJECTIVE: To evaluate real-world patterns of proton pump inhibitor use, treatment compliance, and patient-perceived effectiveness in the control of gastroesophageal reflux symptoms and their impact on quality of life in patients with systemic sclerosis. PATIENTS AND METHODS: We conducted a cross-sectional, patient-reported survey distributed through the Asociación Española de Esclerodermia. Participants provided sociodemographic and clinical data and completed items addressing reflux symptoms and their impact on quality of life, dosing schedule, compliance, and perceived effectiveness in controlling esophageal and extra-esophageal symptoms. RESULTS: A total of 141 patients responded (83% female; mean age 56±10 years; diffuse-subset=56, limited-subset=52). One hundred thirty (92%) reported reflux symptoms, with 54 (42%) developing reflux symptoms before being diagnosed with systemic sclerosis. Current chronic proton pump inhibitors use was reported by 116 (82%) patients, of whom 24% took the medication incorrectly. Symptom control varied by symptom type: heartburn and thoracic pain showed the highest response rates (77% and 67% patients reporting partial or complete effectiveness, respectively), whereas other symptoms, such as regurgitation, dysphonia and globus remained poorly controlled (57%, 47% and 51% mild or no effectiveness, respectively). Despite patients reporting persistent reflux symptoms on proton pump inhibitor therapy, only 37% were prescribed prokinetics and 35% were prescribed mucosal protective agents as adjuvant therapy. CONCLUSIONS: Proton pump inhibitors remain the cornerstone of reflux symptom management in systemic sclerosis but demonstrate limited effectiveness and frequent errors in administration. While patient satisfaction with heartburn control is acceptable, persistent esophageal and extra-esophageal symptoms suggest additional, non-acid-related mechanisms.
Escuin Sanmartin M, Bernal Bandres G, García Mateo S
… +10 more, Ceamanos Ibarra E, Latre Santos M, Navarro Pueyo A, Fernández Arquillué M, Galochino Ballano M, López de la Cruz J, Aso Gonzalvo MC, Ortiz de Solorzano Reig M, Aguilar Muñiz A, Llorente Barrio M
BACKGROUND: The lack of standardised protocols for the pathological assessment of pancreatic resection specimens in pancreatic ductal adenocarcinoma results in substantial variability in diagnostic practice, with relevan...BACKGROUND: The lack of standardised protocols for the pathological assessment of pancreatic resection specimens in pancreatic ductal adenocarcinoma results in substantial variability in diagnostic practice, with relevant clinical and organisational implications. OBJECTIVE: To present a position statement of the Societat Catalana de Pàncrees (SCPanc) and the Societat Catalana d'Anatomia Patològica (SCAP) on the pathological assessment of pancreatic resection specimens in exocrine pancreatic cancer. METHODS: Both scientific societies appointed a panel of experts in pancreatic pathology. The document was developed through a narrative literature review, iterative expert meetings and consensus-based definition of practical clinical scenarios. CONTENT: Specimen reception and fixation; grossing protocol; margin sampling (including vascular resections); staging (TNM) and treatment response; reporting templates; practical appendices. CONCLUSIONS: This position statement provides an original, practice-oriented and consensus-based framework for the pathological assessment of pancreatic resections, aiming to harmonise reporting and support high-quality routine diagnostic practice.
OBJECTIVE: The purpose of this review was to examine evidence on the association between poor sleep quality and disease activity in inflammatory bowel disease (IBD). PATIENTS AND METHODS: PubMed, Embase, Scopus, and the...OBJECTIVE: The purpose of this review was to examine evidence on the association between poor sleep quality and disease activity in inflammatory bowel disease (IBD). PATIENTS AND METHODS: PubMed, Embase, Scopus, and the Web of Science were searched till July 15, 2025, for studies reporting an association between sleep quality and IBD. Outcomes were pooled as odds ratio (OR) in a random-effects meta-analysis model. RESULTS: Twenty studies were included. Most studies were cross-sectional. The majority used the Pittsburgh Sleep Questionnaire Index for assessing sleep quality. Meta-analysis showed that poor sleep quality was significantly associated with active disease in IBD (OR: 2.54 95% CI: 1.85, 3.49 I=80%). Subgroup analysis showed a significant association between poor sleep quality and active disease in CD, but not in UC. In subgroup analyses based on study design, results were significant only in cross-sectional studies, not in cohort studies. Meta-regression analysis using the moderators: sample size, age, males, body mass index, disease duration, prevalence of active disease and poor sleep quality, IBD surgery, and Newcastle-Ottawa scale score did not show significant results. CONCLUSIONS: Low-quality evidence, mostly from cross-sectional data, suggests an association between poor sleep quality and active disease in IBD. However, the findings were not replicated by prospective cohort studies. Given the predominance of cross-sectional data, the possibility of reverse causation, whereby active disease itself leads to impaired sleep quality, cannot be excluded. Further robust studies are needed to support these findings.
OBJECTIVE: To evaluate the diagnostic accuracy of five non-invasive fatty liver indices and their association with obesity in a large cohort of Spanish workers, stratified by sex. PATIENTS AND METHODS: A cross-sectional...OBJECTIVE: To evaluate the diagnostic accuracy of five non-invasive fatty liver indices and their association with obesity in a large cohort of Spanish workers, stratified by sex. PATIENTS AND METHODS: A cross-sectional analysis was conducted on 386,924 workers (232,814 men and 154,110 women) who underwent routine occupational health assessments between 2009 and 2019. Anthropometric, clinical, and biochemical parameters were collected following standardized procedures. Physical activity and adherence to the Mediterranean diet were assessed using validated IPAQ and PREDIMED questionnaires. Diagnostic performance was evaluated using ROC curves and area under the curve (AUC) values for each fatty liver index. RESULTS: All indices showed significant sex-based differences. FLI and LAP presented the highest AUC values for identifying obesity in both sexes (FLI: AUC 0.907 in men and 0.972 in women; LAP: AUC 0.836 in men and 0.878 in women). FLI also demonstrated the strongest association with higher obesity prevalence across tertiles. ZJU showed good performance, whereas HSI and FLD exhibited lower accuracy, particularly among men. Lifestyle factors and education level influenced index values, with sedentary behavior, low adherence to the Mediterranean diet, and lower educational attainment associated with worse index performance. CONCLUSIONS: FLI and LAP are the most accurate non-invasive indices for identifying obesity-associated fatty liver in this large Spanish working population. Their performance varies by sex and is influenced by sociodemographic and lifestyle factors. These findings support the relevance of FLI and LAP for large-scale screening and highlight the importance of integrating lifestyle assessments into occupational health evaluations. .
OBJECTIVE: Malnutrition is a serious complication of inflammatory bowel disease (IBD), associated with increased morbidity, postoperative complications, and reduced quality of life. While well-documented in Western popul...OBJECTIVE: Malnutrition is a serious complication of inflammatory bowel disease (IBD), associated with increased morbidity, postoperative complications, and reduced quality of life. While well-documented in Western populations, data on nutritional status in understudied IBD populations remain scarce. This study aims to comprehensively evaluate the nutritional status of an IBD cohort at a tertiary referral center in Algeria using multiple assessment tools, to identify factors associated with malnutrition, and to explore the relationship between inflammatory activity and nutritional parameters. PATIENTS AND METHODS: A prospective cross-sectional study was conducted at a tertiary referral center. Nutritional assessment included anthropometric measurements, biochemical parameters, and four validated scores: CONUT, McClave, HALP, and GLIM criteria. Disease activity was assessed using the Harvey-Bradshaw Index for Crohn's disease and the Partial Mayo Score for ulcerative colitis. RESULTS: Ninety patients were included forming a Crohn's-dominant cohort (94.4% Crohn's disease). Mean age was 39.5±13.7 years, 53.3% female. Overall, 24.4% had active disease. Nutritional assessment revealed: 18.9% had low BMI (<18.5kg/m). Malnutrition prevalence varied by tool: CONUT 46.7%, McClave 20.6%, HALP 26.8%, and GLIM 14.6%. Active disease significantly correlated with nutritional deterioration and worse nutritional scores (p<0.01). Multivariate logistic regression analysis was performed indicates that although clinical flare and hospitalization were associated with malnutrition in univariate analysis, none of the variables reached statistical significance in the multivariate analysis. CONCLUSIONS: Malnutrition is highly prevalent in IBD patients, particularly during active disease. The inflammatory process plays a crucial role in nutritional deterioration. Systematic nutritional screening using composite scores should be integrated into routine management, especially during disease flares.
Romero-Gómez M, Escalada J, Noguerol M
… +13 more, Pérez A, Carretero J, Crespo J, Mascort JJ, Aguilar I, Tinahones F, Cañones P, Gómez-Huelgas R, de Luis D, Genúa Trullos I, Aller R, Rubio MA, Luis Calleja J
Metabolic hepatic steatosis (MetHS) is a clinically heterogeneous, multisystemic, dynamic, and complex disease, whose progression is one of the main causes of cirrhosis and hepatocarcinoma. This clinical practice guideli...Metabolic hepatic steatosis (MetHS) is a clinically heterogeneous, multisystemic, dynamic, and complex disease, whose progression is one of the main causes of cirrhosis and hepatocarcinoma. This clinical practice guideline aims to respond to its main challenges, both in terms of disease burden and complexity. To this end, recommendations have been proposed to experts through the Delphi method. The consensus was optimal in recommendations regarding type 2 diabetes as a risk factor (1.5.1, 4.5.1), in which cases early detection of MetHS should be carried out (4.5.2). Its results also emphasize the importance of the use of non-invasive tests (FIB-4, NFS, HFS) for the exclusion of significant fibrosis in patients with suspected MetHS (2.3.1, 2.3.3). Diagnosis should be carried out through the sequential combination of non-invasive indices and transient elastography by FibroScan® for its risk stratification (2.3.3). A nearly unanimous consensus was reached regarding the role of early prevention in the impact on the quality of life and survival of patients (5.1.2), as well as on the effectiveness of the Mediterranean diet and physical exercise in relation to the improvement of steatosis, steatohepatitis and fibrosis in MetHS patients (5.2.2) and on the positive results offered by resmiterom and semaglutide in promoting fibrosis regression (5.4.1). Finally, a great consensus has been reached regarding the importance of multidisciplinary management in MetHS, for which it is essential to agree on multidisciplinary protocols for referral between levels in each health area (6.2.1), as well as ensuring that referrals to Hepatology/Digestive and Endocrinology or Internal Medicine services are effective and beneficial to prevent the risk of disease progression (6.2.3, 6.3.1).
BACKGROUND AND OBJECTIVE: Helicobacter pylori (H. pylori) colonizes the gastric mucosa in approximately half of the global population and is a well-established risk factor for peptic ulcer disease and gastric adenocarcin...BACKGROUND AND OBJECTIVE: Helicobacter pylori (H. pylori) colonizes the gastric mucosa in approximately half of the global population and is a well-established risk factor for peptic ulcer disease and gastric adenocarcinoma. Data on the effectiveness of levofloxacin-based eradication regimens in Argentina remain scarce. The objective of the study was to evaluate the eradication efficacy of a 14-day levofloxacin-containing triple therapy regimen in treatment-naïve patients with H. pylori infection. PATIENTS AND METHODS: This single-center retrospective study included treatment-naïve adult patients with histologically confirmed H. pylori infection between 09/2020 and 07/2023. Patients received a 14-day regimen consisting of amoxicillin 1g twice daily, levofloxacin 500mg once daily, and pantoprazole 40mg twice daily. Eradication was assessed by C-urea breath test performed at least 4 weeks following treatment completion. RESULTS: The study included 277 patients (median age 57 years; 60.6% female). The eradication rate was 76.2% evaluated through modified intention to treat analysis. Eradication rates did not differ by age, sex, body mass index, or other baseline clinical characteristics. Treatment-related adverse events occurred in 11 (4%) patients and 6 (2.2%) patients did not complete the prescribed treatment regimen due to adverse events. CONCLUSION: The 14-day levofloxacin-based triple therapy regimen achieved a suboptimal H. pylori eradication rate, falling below the internationally recommended threshold above 90%. These results indicate this regimen should not be considered as first-line therapy in our region, and alternative regimens with higher efficacy should be prioritized.
AIM: Eosinophilic esophagitis (EoE) is a chronic and progressive inflammatory disease with increasing prevalence and incidence worldwide. The objective was to determine the differences in epidemiological, clinical, and t...AIM: Eosinophilic esophagitis (EoE) is a chronic and progressive inflammatory disease with increasing prevalence and incidence worldwide. The objective was to determine the differences in epidemiological, clinical, and treatment characteristics between pediatric and adult patients with EoE in Colombia. PATIENTS AND METHODS: A cross-sectional comparative study was conducted with two independent cohorts of pediatric and adult patients at multiple Colombian centers. RESULTS: 286 patients with EoE were analyzed, 143 children and 143 adults, with a predominance of males (61.9%). Regarding symptom onset and time to diagnosis, adults sought medical attention earlier than children (<6 months: 42.0% vs. 22.8%, p=0.014). Adults presented with more dysphagia (70.0% vs. 32.2%, P <0.001) and food impaction (21.0% vs. 2.8%, P <0.001), and less weight loss (4.2% vs. 25.7%, P <0.001), compared to children. Regarding treatment, adults received more proton pump inhibitors (87.4% vs. 41.1%, p <0.001) and more topical steroids (29.4% vs. 16.1%, p=0.07) than children. The use of systemic corticosteroids was very low in both groups (1.4% vs. 2.8%, p=0.684). There were no significant differences in dietary treatment (40.0% vs. 32.9%, p=0.797). CONCLUSIONS: Eosinophilic esophagitis in Colombia affects both children and adults and shows clear differences in allergic history, clinical presentation, and treatment strategies. These findings highlight variability in clinical practice between pediatric and adult gastroenterologists within the national context.
OBJECTIVE: Approximately 20% of the patients with Crohn's disease (CD) undergo intestinal resection within the first five years from diagnosis. Postoperative recurrence (POR) occurs in many even if preventive therapies a...OBJECTIVE: Approximately 20% of the patients with Crohn's disease (CD) undergo intestinal resection within the first five years from diagnosis. Postoperative recurrence (POR) occurs in many even if preventive therapies are started early after surgery. In this scenario, treatment escalation is recommended; although scarce data are available, faecal calprotectin (FC) has been proposed as the best non-invasive monitoring tool. The aim of this study is to explore the utility of FC for monitoring the treatment response of endoscopic POR (ePOR). PATIENTS AND METHODS: A single-centre retrospective study of patients with CD treated because of ePOR and from whom baseline and follow-up FC measurements as well as an ileocolonoscopic assessment were available. Primary endpoint was endoscopic improvement (decrease in the Rutgeerts' endoscopic score [RES]). RESULTS: Twenty-two patients with ePOR in whom treatment escalation was started were included. ePOR was treated with anti-TNF in 13 patients (59%), thiopurines in 4 (15%), ustekinumab in 3 (13%) and vedolizumab in 2 (10%). After a median clinical follow-up of 23 months, endoscopic improvement was observed in 68% (n=15). At baseline, 14 patients (64%) had FC levels >200μg/g; endoscopic improvement was observed in 11 (73%) of these and 7 (65%) reduced FC values <200μg/g. All patients with persistence of mucosal lesions remained with FC values >200μg/g. FC levels <250μg/g immediately before endoscopic assessment showed 70% sensitivity and 100% specificity (when baseline FC >200μg/g) for the prediction of endoscopic improvement. CONCLUSIONS: Monitoring FC after treatment escalation for ePOR may be useful for the non-invasive monitoring of endoscopic response.
INTRODUCTION: Clostridioides difficile infection (CDI) is the leading cause of healthcare-associated infectious diarrhea and is associated with significant morbidity and mortality, primarily due to its high recurrence ra...INTRODUCTION: Clostridioides difficile infection (CDI) is the leading cause of healthcare-associated infectious diarrhea and is associated with significant morbidity and mortality, primarily due to its high recurrence rate. For this reason, the Catalan Society of Gastroenterology commissioned the development of a position paper aimed at providing practical recommendations, grounded in scientific evidence and expert consensus, on the diagnosis and management of CDI. METHODS: This position paper was developed by specialists in Gastroenterology, Infectious Diseases and Microbiology. It was based on a non-systematic review of the scientific evidence. Recommendations were formulated through expert consensus. RESULTS: The document presents a structured approach to the diagnosis and treatment of CDI, emphasizing individualized management and strategies to reduce recurrence rates. Key components include the role of fecal microbiota transplantation and a therapeutic algorithm informed by disease severity and by whether the episode is initial or recurrent. CONCLUSIONS: This position paper aims to serve as a practical, evidence-based guide for healthcare professionals involved in the clinical management of CDI, promoting the implementation of optimal therapeutic strategies and addressing the main challenges associated with this infection.
OBJECTIVE: There is little information available at the national level on inflammatory bowel disease (IBD) in Argentina. The objective was to describe the methodology of the Argentinian Crohn's Disease and Ulcerative Col...OBJECTIVE: There is little information available at the national level on inflammatory bowel disease (IBD) in Argentina. The objective was to describe the methodology of the Argentinian Crohn's Disease and Ulcerative Colitis Registry (RADECCU). PATIENT AND METHODS: RADECCU was developed in 2023 with the aim of facilitating the collection of relevant information from patients with IBD in Argentina. After the registry's website platform was developed (01/2023), a nationwide promotion campaign was carried out to incorporate centers into RADECCU. RESULTS: From 02/2023 to 6/2025, 69 centers (41 private, 28 public) were incorporated, including 142 professionals, and 4081 patients (2275 women and 1806 men) were enrolled in the registry. CONCLUSION: RADECCU is the first national IBD registry in Argentina. This registry will provide information on the status of IBD in Argentina and contribute to Latin American data with the potential to generate real-world evidence on different aspects of interest.